15 health deficiencies
Top issue: Administration (5 deficiencies)
10 fire-safety deficiencies
Top issue: Smoke (5 deficiencies)
Hancock, MI
1-star overall rating with 1-star inspections with Special Focus status with $180,775 in total fines with 15 recent health deficiencies with 10 fire-safety deficiencies in the latest cycle
1400 Poplar Street, Hancock, MI
(906) 482-6644
Overall
1 / 5
CMS overall stars
Health inspections
1 / 5
Survey and complaint cycles
Staffing
4 / 5
RN + nurse staffing
Quality measures
3 / 5
Resident outcomes and process measures
Quick facts
Beds
39
Certified beds
Average residents
37
Average occupied residents
Ownership
For-Profit
Publicly displayed owner type
Chain
Mission Point Healthcare Services
Operator or chain grouping
Approved since
1994-07-01
CMS approved date
Coverage
Medicare + Medicaid
Participation flags
Staffing
RN hours / resident day
1.41
Registered nurse staffing
LPN hours / resident day
0.42
Licensed practical nurse staffing
Aide hours / resident day
2.09
Nurse aide staffing
Weekend hours
3.32
Weekend nurse staffing
RN turnover
36%
Annual RN turnover
Total nurse turnover
61%
Annual nurse turnover
Quality measures
| Measure | Facility | State | National | Note |
|---|---|---|---|---|
| Number of hospitalizations per 1000 long-stay resident days | 1.1 |
1.7
0.6 pts better
|
1.9
0.8 pts better
|
Long Stay · 20240701-20250630 |
| Number of outpatient emergency department visits per 1000 long-stay resident days | 2.4 |
1.5
0.9 pts worse
|
1.8
0.6 pts worse
|
Long Stay · 20240701-20250630 |
| Percentage of long-stay residents assessed and appropriately given the pneumococcal vaccine | 98.7% |
95.0%
3.7 pts better
|
93.4%
5.3 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents assessed and appropriately given the seasonal influenza vaccine | 100.0% |
95.0%
5 pts better
|
95.5%
4.5 pts better
|
Long Stay · 2024Q3-2025Q2 |
| Percentage of long-stay residents experiencing one or more falls with major injury | 4.7% |
3.1%
1.6 pts worse
|
3.3%
1.4 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who have depressive symptoms | 5.2% |
4.1%
1.1 pts worse
|
11.4%
6.2 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who lose too much weight | 4.9% |
5.5%
0.6 pts better
|
5.4%
0.5 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who received an antianxiety or hypnotic medication | 16.6% |
19.6%
3 pts better
|
19.6%
3 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who received an antipsychotic medication | 19.8% |
16.5%
3.3 pts worse
|
16.7%
3.1 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents who were physically restrained | 0.0% |
0.1%
0.1 pts better
|
0.1%
0.1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents whose ability to walk independently worsened | 6.3% |
13.9%
7.6 pts better
|
16.3%
10 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents whose need for help with daily activities has increased | 8.1% |
11.7%
3.6 pts better
|
14.9%
6.8 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder | 0.0% |
0.9%
0.9 pts better
|
1.0%
1 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with a urinary tract infection | 3.4% |
1.7%
1.7 pts worse
|
1.7%
1.7 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with new or worsened bowel or bladder incontinence | 16.6% |
20.4%
3.8 pts better
|
19.8%
3.2 pts better
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of long-stay residents with pressure ulcers | 6.4% |
5.6%
0.8 pts worse
|
5.1%
1.3 pts worse
|
Long Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents assessed and appropriately given the pneumococcal vaccine | 92.1% |
82.8%
9.3 pts better
|
81.7%
10.4 pts better
|
Short Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents who had an outpatient emergency department visit | 5.0% |
11.5%
6.5 pts better
|
12.0%
7 pts better
|
Short Stay · 20240701-20250630 |
| Percentage of short-stay residents who newly received an antipsychotic medication | 9.5% |
1.3%
8.2 pts worse
|
1.6%
7.9 pts worse
|
Short Stay · 2024Q4-2025Q3 |
| Percentage of short-stay residents who were rehospitalized after a nursing home admission | 14.2% |
24.2%
10 pts better
|
23.9%
9.7 pts better
|
Short Stay · 20240701-20250630 |
Survey summary
Top issue: Administration (5 deficiencies)
10 fire-safety deficiencies
Top issue: Smoke (5 deficiencies)
Top issue: Quality of Life and Care (6 deficiencies)
20 fire-safety deficiencies
Top issue: Smoke (8 deficiencies)
Top issue: Quality of Life and Care (3 deficiencies)
12 fire-safety deficiencies
Top issue: Smoke (3 deficiencies)
Fire safety
Fire Safety
Conduct testing and exercise requirements.
Corrected 2025-09-12
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2025-09-12
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2025-10-10
Fire Safety
Properly select, install, inspect, or maintain portable fire extinguishes.
Corrected 2025-09-12
Fire Safety
Install corridor and hallway doors that block smoke.
Corrected 2025-09-12
Fire Safety
Provide a written emergency evacuation plan.
Corrected 2025-09-12
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2025-09-12
Fire Safety
Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
Corrected 2025-09-12
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2025-09-12
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2025-09-12
Fire Safety
Address subsistence needs for staff and patients.
Corrected 2024-09-12
Fire Safety
Establish policies and procedures including evacuation.
Corrected 2024-09-12
Fire Safety
List the names and contact information of those in the facility.
Corrected 2024-09-12
Fire Safety
Develop and maintain an Emergency Preparedness Program (EP).
Corrected 2024-09-12
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2024-09-12
Fire Safety
Provide properly protected cooking facilities.
Corrected 2024-09-25
Fire Safety
Install a fire alarm system that can be heard throughout the facility.
Corrected 2024-09-12
Fire Safety
Have approved installation, maintenance and testing program for fire alarm systems.
Corrected 2024-09-12
Fire Safety
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
Corrected 2024-09-12
Fire Safety
Inspect, test, and maintain automatic sprinkler systems.
Corrected 2024-09-12
Fire Safety
Follow proper procedures when the automatic sprinkler systems was out of service for more than 10 hours.
Corrected 2024-09-12
Fire Safety
Have simulated fire drills held at unexpected times.
Corrected 2024-09-12
Fire Safety
Have restrictions on the use of portable space heaters.
Corrected 2024-09-12
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2024-09-12
Fire Safety
Provide exit doors that are held open by devices that will automatically close on the activation of a fire alarm or smoke detector.
Corrected 2024-09-12
Fire Safety
Have exits that are accessible at all times.
Corrected 2024-09-12
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2024-09-12
Fire Safety
Install smoke barrier doors that can resist smoke for at least 20 minutes.
Corrected 2024-09-12
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2024-09-12
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2024-09-12
Fire Safety
Create arrangements with other facilities to receive patients.
Corrected 2023-08-14
Fire Safety
Conduct risk assessment and an All-Hazards approach.
Corrected 2023-08-14
Fire Safety
Have exits that are accessible at all times.
Corrected 2023-11-30
Fire Safety
Install emergency lighting that can last at least 1 1/2 hours.
Corrected 2023-08-14
Fire Safety
Provide properly protected cooking facilities.
Corrected 2023-08-14
Fire Safety
Have properly installed electrical wiring and gas equipment.
Corrected 2023-08-21
Fire Safety
Provide a written emergency evacuation plan.
Corrected 2023-08-14
Fire Safety
To conduct inspection, testing and maintenance of fire doors by qualified individuals.
Corrected 2023-08-14
Fire Safety
Have generator or other power source capable of supplying service within 10 seconds.
Corrected 2023-08-14
Fire Safety
Ensure that special areas are constructed so that walls can resist fire for one hour or have an approved fire extinguishing system.
Corrected 2023-08-14
Fire Safety
Ensure proper usage of power strips and extension cords.
Corrected 2023-08-14
Fire Safety
Install an approved automatic sprinkler system.
Corrected 2023-08-14
Inspection history
Health
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Corrected 2025-08-25
Health
Employ sufficient staff with the appropriate competencies and skills sets to carry out the functions of the food and nutrition service, including a qualified dietician.
Corrected 2025-08-25
Health
Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Corrected 2025-08-25
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2025-08-25
Health
Administer the facility in a manner that enables it to use its resources effectively and efficiently.
Corrected 2025-08-25
Health
Have a plan that describes the process for conducting QAPI and QAA activities.
Corrected 2025-08-25
Health
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Corrected 2025-08-25
Health
Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Corrected 2025-08-25
Health
Implement a program that monitors antibiotic use.
Corrected 2025-08-25
Health
Designate a qualified infection preventionist to be responsible for the infection prevent and control program in the nursing home.
Corrected 2025-08-25
Health
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Corrected 2025-08-25
Health
Ensure residents do not lose the ability to perform activities of daily living unless there is a medical reason.
Corrected 2025-08-25
Health
Provide safe and appropriate respiratory care for a resident when needed.
Corrected 2025-08-25
Health
Ensure medication error rates are not 5 percent or greater.
Corrected 2025-08-25
Health
Inform resident or representatives choice to enter into binding arbitration agreement and right to refuse.
Corrected 2025-08-25
Health
Make sure that a working call system is available in each resident's bathroom and bathing area.
Corrected 2025-01-06
Health
Give residents a notice of rights, rules, services and charges.
Corrected 2025-01-06
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2025-01-06
Health
Provide enough food/fluids to maintain a resident's health.
Corrected 2025-01-06
Health
Provide and implement an infection prevention and control program.
Corrected 2024-09-12
Health
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Corrected 2024-09-12
Health
Ensure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.
Corrected 2024-09-12
Health
Observe each nurse aide's job performance and give regular training.
Corrected 2024-09-12
Health
Post nurse staffing information every day.
Corrected 2024-09-12
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2024-09-19
Health
Conduct and document a facility-wide assessment to determine what resources are necessary to care for residents competently during both day-to-day operations (including nights and weekends) and emergencies.
Corrected 2024-09-12
Health
Electronically submit to CMS complete and accurate direct care staffing information, based on payroll and other verifiable and auditable data.
Corrected 2024-09-12
Health
Implement a program that monitors antibiotic use.
Corrected 2024-09-12
Health
Educate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.
Corrected 2024-09-12
Health
Regularly inspect all bed frames, mattresses, and bed rails (if any) for safety; and all bed rails and mattresses must attach safely to the bed frame.
Corrected 2024-09-12
Health
Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
Corrected 2024-09-12
Health
Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.
Corrected 2024-09-19
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2024-09-12
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2024-09-12
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2024-09-12
Health
Ensure that staff members are educated on resident rights and facility responsibilities to properly care for its residents.
Corrected 2024-09-12
Health
Conduct mandatory training, for all staff, on the facility’s Quality Assurance and Performance Improvement Program.
Corrected 2024-09-12
Health
Include as part of its infection prevention and control program, mandatory training that includes written standards, policies, and procedures for the program.
Corrected 2024-09-12
Health
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Corrected 2024-09-12
Health
Prepare residents for a safe transfer or discharge from the nursing home.
Corrected 2024-06-07
Health
Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Corrected 2024-05-29
Health
Provide medically-related social services to help each resident achieve the highest possible quality of life.
Corrected 2024-06-07
Health
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Corrected 2024-04-26
Health
Respond appropriately to all alleged violations.
Corrected 2024-04-26
Health
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Corrected 2023-08-14
Health
Provide and implement an infection prevention and control program.
Corrected 2023-08-14
Health
Make sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.
Corrected 2023-08-14
Health
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Corrected 2023-08-14
Health
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Corrected 2023-08-14
Health
Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Corrected 2023-08-14
Health
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Corrected 2023-08-14
Health
Provide appropriate care for residents who are continent or incontinent of bowel/bladder, appropriate catheter care, and appropriate care to prevent urinary tract infections.
Corrected 2023-08-14
Penalties and ownership
Fine · fine $180,775
Fine
Payment Denial · denial start 2024-09-06 · 13 days
13 day denial
5% Or Greater Indirect Ownership Interest · Individual
5% Or Greater Direct Ownership Interest · Organization
Corporate Officer · Individual
Operational/Managerial Control · Organization
W-2 Managing Employee · Individual
W-2 Managing Employee · Individual
Nearby options
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